Liver functions test

1.Synthetic functions tests a. total plasma proteins (TP)

b. albumin (Alb)
c. albumin /globulin ratio (A/G)

2.Excretion functions tests a. Total bilirubin (TB)

b. Direct bilirubin (Conjugated bilirubin )
c. Indirect bilirubin (Unconjugated bilirubin )

3.Inflammation and tissues damage tests

a. Alanine transaminase (ALT)
b. Aspartate transaminase(AST)
c. alkaline phosphatase (ALP)
d. Gama glutamyl transaminase (GGT)
Proteins Synthetic function tests
Serum Total proteins and
fractions
• The major types of proteins present in the plasma are
albumin, globulins and fibrinogen, while in serum the
two most important protein fractions are albumin and
globulins only.
• Plasma proteins are mostly synthesized in the
hepatocytes, except for the immunoglobulins which
are synthesized in the lympho-reticular system.
The main functions of proteins in blood are

a) coagulation
b) host defenses against pathogens
c) transport of metabolites, regulation of cellular
metabolism
d) maintaining osmotic pressure
• The concentrations of plasma proteins may be altered
in diseases that alter protein synthesis process in the
liver, the distribution of proteins, their rate of
catabolism and rate of excretion
• It can occur as the result of malnutrition,
malabsorption, physiological status, infections and
inflammations, therefore plasma proteins are a
reliable and important health indicators.
• Determination of Serum total
proteins is by Biuret method
 Serum Albumin
• Albumin is the most abundant plasma protein in
human.
• It accounts for about 60% of the total plasma
proteins.
• liver is the primary site of albumin synthesis, and
small amounts of albumin may be synthesized in the
mammary glands and skeletal muscle
• its half-life in plasma is 20 days.
 Albumin plays important physiological
roles, including
1. maintenance of colloid osmotic pressure
2. binding of key substances such as long-chain fatty
acids, bile acids, bilirubin, calcium and
magnesium.
3. has anti-oxidant and anticoagulant effects
4. a carrier for nutritional factors and drugs.
5. Serum albumin is a reliable prognostic indicator
for morbidity and mortality in liver disease,
nephritic syndrome, malnutrition and protein-
losing enteropathies.
• Measurement serum albumin by
Bromocresol green method (BCG)
method)
 Albumin / Globulin (A/G) ratio
useful in the evaluation of liver and kidney disease.
The ratio is calculated using the following formula:

Albumin/(total protein – albumin)

where globulin is the difference between the total protein
value and the albumin value.

• For example, with a total protein of 7 g/dL and albumin of 4 g/dL,

the A/G ratio is calculated as 4 / (7 – 4) or 4/3 = 1.33.

• A reversal in the ratio where globulin exceeds albumin

(i.e., ratio less than 1.0) is clinically significant.
• Normally the albumin/globulin (A/G) ratio is >1.
Indications of A/G ratio

1. Assess nutritional status of hospitalized

patients, especially geriatric patients.
2. Evaluate chronic illness
3. Evaluate liver disease.
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